Provider Demographics
NPI:1013033133
Name:CAMPBELL, GARRETT KING (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:KING
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-0841
Mailing Address - Country:US
Mailing Address - Phone:970-420-1247
Mailing Address - Fax:
Practice Address - Street 1:2573 STATE HIGHWAY 522
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556-0290
Practice Address - Country:US
Practice Address - Phone:575-586-0331
Practice Address - Fax:575-586-0519
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COD70431223G0001X
NMDB-2023-03071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice